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AMK > Neurology > Flashcards

Neurology Flashcards

1
Q

What is myasthenia gravis?

A

Autoimmune neuromuscular disease characterised by muscle weakness

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2
Q

Age groups affected by myasthenia graves

A

Young females, older men

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3
Q

Pathophysiology of myasthenia gravis

A

Autoantibodies against post-synaptic acetylcholine receptors

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4
Q

Sx myasthenia gravis

A

Fatigability

Ptosis, diplopia, difficulty standing and chewing

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5
Q

Mx myasthenia gravis

A

Acetylcholinesterase - pyridostigmine

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6
Q

Drugs to avoid in myasthenia gravis

A

B Blockers
lithium
phenytoin

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7
Q

What is MS?

A

Degenerative disease of CNS caused by inflammation and demyelination

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8
Q

Sx MS

A 
Visual - optic neuritis 
Sensory - paraesthesia and trigeminal neuralgia 
Motor - spastic weakness 
Cerebellar - ataxia and tremor 
Urinary incontinence and fatigue
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9
Q

Dx MS

A

MRI brain - sclerotic plaques

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10
Q

Mx MS

A

B-interferons

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11
Q

What is Huntington’s

A

Autosomal dominant condition caused by repeats of CAG

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12
Q

Sx Huntington’s

A

Cognitive - dementia, behavioural changes

Chorea, dystonia, dysarthria

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13
Q

Tx chorea

A

Tetrabenazine and benzodiazepines

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14
Q

Tx bradykinesia

A

Levodopa

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15
Q

Tx depression

A

SSRI

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16
Q

What is Parkinson’s disease?

A

Neurodegeneration of dopamine neurones in substantia nigra

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17
Q

Sx Parkinson’s

A

Bradykinesia
Tremor at rest
Rigidity
Depression

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18
Q

Mx Parkinson’s

A

Levodopa

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19
Q

Torticollis

A

Systained muscular contraction of neck

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20
Q

Akathisia

A

Restlessness

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21
Q

Febrile convulsions

A

Children 6m-5y, occur due to viral infection, brief and tonic-clonic in nature

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22
Q

Alcohol withdrawal seizures

A

Decreased inhibitory GABA and increased NMDA glutamate due to cessation of drinking, normally 36h after

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23
Q

Non-epileptic seizures

A

No characteristic electrical discharges

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24
Q

Focal seizures

A

Start in a specific area of the brain

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25
Q

Generalised seizures

A

Both sides of brain, lose consciousness, lots of sub-types like tonic-clonic and typical absence

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26
Q

Infantile spasms

A

Flexion of head, trunk and limbs, last 1-2 seconds, mental handicap, due to neurological abnormality

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27
Q

Simple partial seizures

A

Focal and aware

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28
Q

Complex partial seizures

A

Focal and impaired

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29
Q

Temporal seizure sx

A

Hallucinations and automatisms

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30
Q

Frontal lobe seizure sx

A

Motor - head/leg movements

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31
Q

Parietal lobe seizure sx

A

Paraesthesia (sensory)

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32
Q

Occipital lobe seizure sx

A

Floaters/flashes

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33
Q

first line treatment for generalised seizures

A

sodium valproate

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34
Q

second line treatment for generalised seizures

A

lamotrigine

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35
Q

first line treatment for focal seizures

A

carbamazepine

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36
Q

second line treatment for focal seizures

A

sodium valproate

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37
Q

what is a hypnagogic jerk

A

just as you are about to fall asleep

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38
Q

what should you do if seizure lasts more than 10 mins

A

benzodiazepine - diazepam under tongue

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39
Q

Acute closed angle glaucoma sx

A
  • Severe pain - ocular or headache
  • Decreased visual acuity
  • Sx worse with mydriasis
  • Hard/red eye
  • Non-reacting pupil
  • Systemic upset - nausea/vomiting/abdo pain
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40
Q

treatment of acute closed angle glaucoma

A
  • Parasympathomimetic - pilocarpine - increases outflow

- B-blocker - propanolol - decreases humour production

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41
Q

Alzheimer’s pathophys

A

Mutations in amyloid precursor proetin (chr21), presenilin 1 (chr14) and presenilin 2 (chr1) are risk factors

Macroscopic changes:

  • Cerebral atrophy - cortex and hippocampus

Microscopic changes:

  • AB plaques and tau tangles
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42
Q

medical treatment Alzheimer’s

A

Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild-moderate

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43
Q

Where is the lesion in wernicke’s aphasia?

A

Superior temporal gyrus - supplied by inferior MCA

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44
Q

sx wernicke’s

A

pt has fluent speech but no meaning - comprehension is impaired

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45
Q

Where is the lesion in Broca’s aphasia

A

Lesion in inferior frontal gyrus (supplied by superior left MCA)

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46
Q

sx Broca’s aphasia

A

normal comprehension but can’t speak

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47
Q

conduction aphasia

A

speech is fluent but repetition is poor, comprehension is normal

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48
Q

area of brain affected by conduction aphasia

A

arcuate fasiculus

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49
Q

global aphasia

A

severe expressive and receptive aphasia

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50
Q

what is arnold-chiari malformation

A

Downward displacement/herniation of cerebellar tonsils through foramen magnum

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51
Q

Sx Bell’s palsy

A
  • LMN facial nerve palsy - forehead affected
  • Post-auricular pain
  • anterior 2/3 tongue (cn7)
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52
Q

which CN is affected in Bell’s palsy

A

7

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53
Q

tx Bell’s palsy

A
  • Prednisolone within 72h

- Refer to ENT if 3 weeks with no improvement

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54
Q

erb’s palsy

A
  • Damage to C5-6 roots
  • Winged scapula
  • May be caused by breech presentatio
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55
Q

klumpke’s palsy

A
  • Damage to T1
  • Loss of intrinsic hand muscles
  • Forearm supinated, wrist and fingers flexed
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56
Q

are brain lesions contralateral or ipsilateral

A

contralateral

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57
Q

parietal lobe lesion

A

sensation changes, inferior homonymous quadrantopia

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58
Q

occipital lobe lesion

A

homonymous hemianopia, cortical blindness

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59
Q

temporal lobe lesion

A

wernicke’s aphasia, superior homonymous quadrantopia

60
Q

frontal lobe lesions

A

Broca’s aphasia, anosmia

61
Q

cerebellar lesions

62
Q

amygdala lesion

A

Kluvery-Bucy = hypersexuality and agnosia

63
Q

syndromes associated with pituitary adenoma

A

Benign tumours of pituitary gland, cause Cushing’s (ACTH) or acromegaly (GH) and bitemporal hemianopia

64
Q

most common tumour in kids

A

astrocytoma

65
Q

most common brain tumour in adults

A

glioblastoma multiforme

66
Q

symptoms of brown-sequard syndrome

A

Ipsilateral weakness and loss of proprioception and vibration

Contralateral loss of pain and temp

67
Q

sx cerebellar lesion

A
  • D = dysdiadochokinesia
  • A = ataxia
  • N = nystagmus (horizontal)
  • I = intention tremor
  • S = slurred speech
  • H = hypotonia
68
Q

are cerebellar lesions contralateral or ipsilateral

A

ipsilateral

69
Q

sx cerebral palsy

A
  • Abnormal tone
  • Delayed motor milestones
  • Abnormal gait
  • Learning difficulties
  • Epilepsy
70
Q

charcot-marie tooth syndrome sx

A
  • Foot drop
  • High-arched feet
  • Hammer toes
  • History of frequently sprained ankles
71
Q

tx fibromyalgia

A

duloxetine or fluoxetine

72
Q

tx neuropathic pain

A

gabapentin or amitriptyline

73
Q

what is Creutzfeldt-Jakob disease

A

rapidly progressive neurodegeneration due to prion dementia

74
Q

vascular dementia features

A

Cognitive impairment secondary to haemorrhage/ischaemia

75
Q

vascular dementia sx

A

Stepwise deterioration, focal abnormalities, difficulty with attention, gait/memory/speech disturbance

76
Q

Alzheimer’s disease sx

A

Memory loss, poor judgement, getting lost, losing things

77
Q

fronto-temporal dementia features

A

Atrophy of frontal or temporal lobes

78
Q

fronto-temporal dementia sx

A

Onset <65, personality changes, preserved memory, delusions, PICK’S DISEASE

79
Q

lewy-body dementia features

A

Build up of a-synuclein at pre-synaptic terminal = severe acetylcholine decline

80
Q

lewy-body dementia sx

A

Progressive impairment, develops before Parkinson’s, visual hallucinations, depression

81
Q

drugs causing peripheral neuropathy

A 
amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole
82
Q

pathophysiology of muscular dystrophy

A

X-linked recessive disorders due to a mutation in the gene encoding dystrophin (Xp21) which normally connects muscle membrane to actin

83
Q

Duchenne muscular dystrophy

A

More severe
Progressive proximal muscle weakness from 5 y/o
Gower’s sign

84
Q

Becker’s muscular dystrophy

A

Less sevre

>10 y/o

85
Q

organism associated with Guillain barre

A

campylobacter jejune

86
Q

sx guillon barre

A
  • Progressive, symmetrical weakness of all limbs
  • Weakness is ascending (legs affected first)
  • Sensory sx are mild
  • CN involvement
  • Respiratory muscle weakness
  • Urinary retention and diarrhoea
87
Q

extradural haemorrhage

A

Blow to side of head = MMA rupture, pt experiences lucid interval

88
Q

subdural haemorrhage

A

Banana shaped haemorrhage, rupture of bridging veins, alcohol related

89
Q

subarachnoid haemorrhage

A

Sudden, thunderclap occipital headache, ruptured berry aneurysm

90
Q

Kluvery bucy sybndrome

A

hyper sexuality , increased appetite

91
Q

Herpes simplex encephalitis

A

HSV1 infects temporal/occipital lobes

92
Q

Herpes simplex encephalitis sx

A
  • Fever
  • Headache
  • Psychiatric sx
  • Seizures
  • Vomiting
  • Aphasia
  • CSF: lymphocytosis and elevated protein
93
Q

treatment for herpes simplex encephalitis

94
Q

sx Horner’s

A

ptosis, miosis and anhidrosis

95
Q

post-ganglionic Horner’s

A

no anhidrosis

Carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis

96
Q

pre-ganglionic Horner’s

A

anhidrosis of face

Thyroidectomy/trauma

97
Q

central Horner’s

A

anhidrosis of face, arms and trunk

stroke, syringomelia, MS

98
Q

Huntington’s pathophys

A

Autosomal dominant repeat expansion of CAG → degeneration of cholinergic and GABAergic neurons in basal ganglia

Defect in huntingtin gene on chr4

99
Q

Huntington’s sx

A
  • 35+
  • Chorea
  • Personality changes
  • Dystonia
  • Saccadic eye movements
100
Q

idiopathic intracranial hypertension

A

young, overweight females
r/f = female, obese, pregnant, COCP/steroids
Sx = headache, papilloedema, blurry vision

101
Q

Lateral medullary syndrome

A
  • Wallenberg’s syndrome
  • Occlusion of posterior inferior cerebellar artery
  • Ataxia and nystagmus
  • Ipsilateral dysphagia, facial numbness and cranial nerve palsy
  • Contralateral limb sensory loss
102
Q

intracranial venous thrombosis sx

A
  • Headache
  • N and V
  • Reduced consciousness
  • +/- high d-dimer
103
Q

tx intracranial venous thrombosis

A

anticoagulants

104
Q

pathophys Lambert-eaton syndrome

A

Associated with small cell lung cancer or independently as autoimmune disorder

Antibody directed against voltage-gated calcium channels in PNS

105
Q

sx lambert eaton

A
  • Repeated muscle contraction = increased muscle strength
  • Limb-girdle weakness (lower limb first)
  • Hyporeflexia
  • Autonomic sx - dry mouth, impotence etc
106
Q

Sx MND

A
  • Fasciculations
  • Absence of sensory sx
  • Both UMN and LMN lesions
  • Wasting of hand muscles
107
Q

most common type of MND

A

amyotrophic lateral sclerosis

108
Q

myasthenia gravis pathophys

A

antibodies to acetylcholine receptors

109
Q

sx myasthenia gravis

A

fatigue
diplopia and ptosis
muscle weakness
thymoma

110
Q

mx myasthenia gravis

A

acetylcholinesterase inhibitors (pydifostigmine) and immunosuppression (prednisolone

111
Q

sx normal pressure hydrocephalus

A

urinary incontinence, dementia and gait change

112
Q

what is normal pressure hydrocephalus

A

A reversible cause of dementia secondary to reduced CSF re-absorption at arachnoid villi

113
Q

tx normal pressure hydrocephalus

114
Q

pathophys Parkinson’s disease

A

Neurodegeneration of dopaminergic neurones in substantia nigra

115
Q

sx Parkinson’s

A

bradykinesia, resting tremor and rigidity

116
Q

dx Parkinson’s

117
Q

tx parkinson’s

118
Q

pharmacological causes of Parkinson’s

A

antipsychotics and metoclopramdie

119
Q

how to calculate cerebral perfusion pressure

120
Q

reflex changes with sciatic nerve lesion

A

Ankle and plantar reflex lost but knee jerk intact

121
Q

What is thoracic outlet syndrome?

A

Compression of brachial plexus, subclavian artery/vein at site of thoracic outlet

Occurs due to neck trauma or cervical rib

122
Q

sx thoracic outlet sundrome

A

paraesthesia, wasting of hand muscles, oedematous arms

123
Q

What is a TIA

A

Transient episode of neurologic dysfunction caused by brain, spinal cord or retinal ischaemia without acute infarction

124
Q

sx TIA

A

RESOLVE <1hr

  • Unilateral weakness/sensory loss
  • Aphasia or dysarthria
  • Ataxia/vertigo/balance issues
  • Visual changes
125
Q

Tx TIA

A

Immediate aspirin 300mg

Clopidogrel after this

126
Q

causative organism meningitis

A

strep pneumoniae

127
Q

sx meningitis

A
  • Headache
  • Neck stiffness
  • Photophobia
  • Confusion
  • fever
128
Q

treatment for meningitis in adults

A

viral should self-resolve but bacterial = cefitriaxone or acyclovir

129
Q

sx migraine

A
  • Unilateral, throbbing headache
  • nausea, photophobia
  • <72hr
  • Precipitated by aura 5-60 mins
130
Q

treatment for acute migraine

A

triptans - serotonin agonists

131
Q

what is MS

A

autoimmune demyelination in CNS - can be relapsing-remitting, secondary or primary progressive

132
Q

MS sx

A
  • Optic neuritis
  • Worsening vision when body temp rises
  • Paraesthesia
  • Trigeminal neuralgia
  • Spastic leg weakness
  • Ataxia
  • Urinary incontinence
  • Sexual dysfunction
133
Q

mx MS

A

prednisolone

134
Q

causes of CN3 palsy

A

diabetes, vasculitis, PCA aneurysm

135
Q

sx tension headache

A

A bilateral ‘tight band’ around the head - not associated with aura/N+V

136
Q

tx tension headache

A

aspirin/NSAIDs

137
Q

ischaemic stroke

A

blockage in blood vessel

Af is risk factor

138
Q

haemorrhage stroke

A

blood vessels burst = reduced blood flow

139
Q

sx stroke

A
  • motor weakness
  • Speech problems
  • Dysphagia
  • visual field defects
  • contralateral hemiplegia
  • homonymous hemianopia
140
Q

treatment ischameic stroke

A

thrombolysis <4.5h

Aspirin 300mg

141
Q

treatment TIA

A

aspirin 300mg ASAP

142
Q

anterior cerebral artery stroke

A

contralateral leg weakness

143
Q

middle cerebral artery stroke

A

contralateral arm weakness

144
Q

posterior cerebral artery stroke

A

contralateral agnosia and visual field defects

145
Q

basilar artery stroke

A

locked in syndrome

146
Q

specific treatment for absence seizures

A

ethosuximide

AMK (33 decks)

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